How safe is healthcare in prison and what happens when things go wrong?I n this episode of Voices for Safety, our host Dr Louise Gorman speaks with researchers Dr Joy McFadzean, Dr Jake Hard, and Dr Verity Wainwright about a major NIHR-funded study examining avoidable healthcare-associated harm and patient safety in English prisons.

Drawing on the review of more than 15,000 prisoner health records, the study found that UK prisoners are up to 67 times more likely to experience harm whilst receiving healthcare, which could have been avoided if sufficient practices, systems and standards were in place. Researchers from the Universities of Manchester, Nottingham, and Cardiff identified that 247 cases of avoidable harm affected 244 prisoners, estimating that across the prison population in England, around 3,000-3,700 cases of avoidable healthcare harm could occur each year.

In this episode, the team discusses how delays in treatment, communication challenges, prison transfers, staffing pressures, and gaps between healthcare and security systems can affect patient safety.

The conversation explores the complex healthcare needs of people in prison, the barriers they face in accessing care, and why prisoners may be significantly more likely to experience avoidable harm than people receiving healthcare in the community. The guests share real-world examples from the research, discuss the impact of these findings on health inequalities, and consider what changes are needed to improve safety and continuity of care both within prisons and during transitions between prison and community healthcare services.

This episode shines a light on an often-overlooked area of healthcare and highlights why improving patient safety in prisons is an important public health priority.

The research findings emphasise the need for:

• Better healthcare systems for managing long-term health conditions
• Improved communication between both healthcare teams and prison teams, and enhanced use of medical records to record patient care and to ensure that care plans are monitored and enacted upon
• More timely referrals to other healthcare providers
• Greater attention to patient safety within prisons

Listen now on:

The paper The incidence of avoidable healthcare-associated harm in prisons in England: a retrospective case note review was published in BMJ Quality & Safety and is available here. DOI https://doi.org/10.1136/bmjqs-2025-019935

This study was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme and the NIHR Greater Manchester Patient Safety Research Collaboration.

Meet the guests

Dr Joy McFadzean is a General Practitioner and Clinical Lecturer of Patient Safety with a strong interest in medical education, patient safety, and quality improvement. She works with the Primary Care Patient Safety (PISA) Research Group at Cardiff University. She is also the Associate Director of Learning at the World Health Organization Collaborating Centre for Patient Safety Learning and Improvement, led by Professor Andrew Carson-Stevens within the Division of Population Medicine at Cardiff University, where she contributes to advancing safer healthcare by analysing and seeking interventions to overcome avoidable healthcare-associated harms.  

Dr Jake Hard is a prison GP and works as the Associate Clinical Director for Oxlease NHS Foundation Trust covering their prison in the South West. Dr Hard is also a Panel member of the Independent Advisory Panel on Deaths in Custody.

Dr Verity Wainwright is a Chartered Psychologist, Lecturer and Deputy Programme Director on the MSc Forensic Psychology and Mental Health programme at The University of Manchester. She is an experienced researcher within the Health and Justice Research Network focusing on improving health and patient safety in criminal justice settings.

Related stories

Related

[related-posts-thumbnails]